Primary malignant melanoma of the jejunum. A case report

Abstract

Background

Malignant melanomas in the small intestine are commonly encountered as the metastases from primary cutaneous lesions. Even though it’s rare, it can also develop as a primary mucosal tumour in the gastrointestinal tract. We present a rare case of primary jejunal melanoma.

Case presentation

A 72-year-old male was investigated for occult gastrointestinal bleeding following three consecutively positive stool occult blood tests and his haematological investigations showed that severe iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy did not revealed any abnormality. Capsular endoscopy was performed and found to have a distal jejunal lesion with ulceration, bleeding and blackish discolouration. It was unsuccessful, even though we attempted single balloon enteroscopy to reach the site to obtain a biopsy and following contrast enhanced CT of the abdomen and pelvis the distal jejunal mass was confirmed with no abnormality found in the rest of the study. Since the CT further revealed that it was approximately 5 cm tumour arising from the jejunal wall and growing in to the lumen of the jejunum, Ultra sound guided Fine needle aspiration cytology attempted and found to have a blackish pigmented aspiration and later it was confirmed melanin pigment rich aspirate during the cytological examination. The mass was confirmed on laparotomy and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. Following the curative resection the patient recovered uneventfully.

Conclusions

Primary intestinal malignant melanoma in jejunum is an extremely rare occurrence. Complete surgical resection is the treatment of choice. The lymph node metastasis have the worse prognosis.